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HomeMy WebLinkAboutOld permits • Development Services Depart '--""°,l
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:, '}' L,' PERMIT/PLAN REVIEW APIILICATION
...c.,,-.... 1%. Development Services Department,240 West Huntington Drive,Post Office Box 60021
Q.°"t`° Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS' COMPENSATION DECLARATION
Ai hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9, commencing with Section 7000, of Division 3 of the Business and
Professions Code, d my license is in full fo /�c ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. 7 Eicp.Date r3po0 compensation, as provided for by Section 3700 of the Labor Code, for the
�y� performance of the work for which this permit is issued.
Signature of Contractor g i
OWNER—BUILDER DECLARATION ID have and will maintain workers' compensation insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My workers'compensation insurance carrier and policy number are:
License Law for the following reason(Section 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, Carrier
demolish,or repair any structure,prior to its issuance,also requires the applicant
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less.)
7000)of Division 3 of the Business and Professions Code) or that he or she is 441 certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of not employ any person in any manner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil compensation laws of California,and agree that if I should become subject to the
penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. �y,�
❑ I, as owner of the property, and my employees with wages as their sole ` �6/ C��
compensation,will do the work,and the structure is not intended or offered for Date f"h- ApplicanC%%�I,�C
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure workers'compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(I)year of and shall subject an employer to criminal penalities and civil fines up to one
completion,the owner—builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest,and
attorneys fees.
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). g g il
for the performance of the work for which this permit is issued(Section 3097,Civil
Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Owner Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required. A Certificate of Occupancy must be obtained prior to use and occupancy of new
buildings and structures.
3. Per South Coast Air Quality Management District (AQMD) regulations, renovation and remodeling work that results in the removal, stripping, or
altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-
2000 for further information. ,
Name k 6 iii Title glij
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the
owner. I agree to comply with al _'ty o . a es and State laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to • o he abov • ti i ed , 'I perty for inspection purposes.
Signature / /L/// AtA //g Date
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NO OPERATION .._ A NO OPERATION NOTES DU O p^
Building Inspections Date Insp. - mhing Inspections Date Insp. ��_ W
_100. Setbacks 5.2 .03 r� . Under fir./bldg.drain -Or�fj r /1/6 - /, „ - p
X01. Rough grade 211. Copper underslab 'j•2/. .
102. Figs.&forms 5-24-D3 ', 212. Rough plumbing ,0• 3
103. Pre-slab 9-°2/•0) p 213. Roush gas is LI�.ilr 5a Y 5 ill AI.e '
104. Floor joists 214. Shower pan oil" eNer.
105. Steel 215. Water heater
106. Grout lift 216. Roof drains 5b)(5 6715///4011› C6
107. Shear nailing . 217. Building sewer "�
• r i 218. Water service N E?.(c� le o7v ( ��
108. Dinh nailin• �r � �� � �f
109. Roof nailing "/.p3 , 219. Final gas S b 54th Qcs/( '3 2//D7 b <
110. Framing a•Z-p� 220. Fixtures D /�
111. 0cc./Area Sep.Wall 221. Final plumbing '1312p!,
112. Sound walls 222. Sewer cao/demo.
113. T-bar•rid
114. Insulation-flr. •Pool Inspections Date I Insp.
115. Insulation-Wal ' * , 240. Excavation/steel / 5 4.R/' 6ic h 4,/-14
116. Insulation-CeiiC 241. Rough plumbing --//-1
117. Drywall nailing ere-OS 242. Light shell/bonding �� /
118. Interior lath 243. Underground conduit �y ��
119. Exterior lath 3rj'c 'Z 244. P-trap 7V�
120. Finish grade 245. Gas line&test
121. Final building - -s, 246. Fence,sates&Suns 0 -2-D3 / .p/[` -L L /ij ■ A •A
122. Final demo/lot clear 1 247. Pool heater ���/ ,
248. Final electric l v
Electrical Inspections • Date. Insp. 249. Final Plumbing f`_' /,I
150. Power pcle 1
j 250. Pool cover
151. Sales lot lighting 251. Pool final , '�/C. • - � jC?
152. Underground conduit (�‘‘.4 /
.4 S 1 0
153. Underslab conduit Reroof Inspections Date Insp.
154. UFER wound •Avg 03 r 270. Pre-reroof insp. ream -155. Water ground 271. Roof framins MIMI - I ii
156. Rough electrical ,(!• "0 1/i'11MIj ! ���� u .
157. Fixtures 273. Final reroof I�-7-03 '1v rGi d1
158. G.F.C.I. i `."G'' , t, ` • T i,.1. i. .- d. if'
159. Eqpt.bonding . Sign:Inspections I Date Insp. jg I
A , ./,
160. Service panel 280. Setback/overhang
161. Final electric 281. Footing
A - P av alks 282. Conduit/wirins if /�G/ # . - •i
Mechanical Inspections I Date Insp. 283. Disconnect • ` ` ��I
180. Venting/flue 234. Final sign
181. Furnace/A.C. i
inaniffmra.19, 10,M,50 A, P ` !,
182. Rouch HVAC p + Miscellaneous Insp. Date Insp.
183. Fire dampers MIN 290. Fire alarm
184. Furnace compartment 291. Underground suppl ��'
185. Combustion air 292. Fire sprinklers G00¢1,1 C/ - 741-
"F
186. Smoke detectors Z15174,-„ ---\ 293. Monitor system
187. Metal F.P.rough /G•?b 3 294. Hood dry them. n��%�!a< \ ��j !n
I(
188. Compressor setback 295. Final !�J
0;
189. Commercial hood I '
190. Duct shaft Sewers&Offsite Insp. Date Insp.
191. Final mechanical ' •/ Vie,/1 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cesspool filled
200. Footings 1 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
NO OPERATION OPERATION • NOTES 1 e I oZ 9A
Building Inspections Date Insp. mbing Inspections I Date I Insp.
100. Setbacks -- 210. Under fir/bldg.drain , a ,d ' 4/1 ■ P MI
101. Rough grade 211. Copper underslab i
102. Figs.&forms 212. Rough plumbing
103. Pre-slab 213. Rough gas
104. Floor joists 214. Shower pan -
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing ' 219. Final gas
110. Framing 220. Fixtures
111. Occ./Area Sep.Wall 221. Final plumbing
112. Sound walls 222. Sewer cap/demo.
113. T-bar grid
114. Insulation-fir. - Pool Inspections Date I Insp.
115. Insulation-Wall - 240. Excavation/steel zi► d /_ °( L/ % Ii
116. Insulation-Ceil. 241. Rough .lumbin• '�V/���.�a� �, //
117. D all nailing 1111- 242. Light shell/bonding �7I��' ILL t .4
118. Interior lath 243. Underground conduit r
119. Exterior lath 244. P-tram -/' ■ a,�/_ ; /
120. Finish mrade 245. Gas line&test �►i�g7./ k i
121. Final building 246. Fence,•ate :,r�aG_ i���n�.. ` ��J -es
122. Final demo/lot clear 247. Pool heater /I_�
248. Final electric
Mil Electrical Inspections Date I Insp. 249. Final Plumbing 1111-4 11111 `I. ,,
150. Power pole 250. Pool cover
•i
151. Sales lot lighting 251. Pool final 'lea t
152. Underground conduit
153. Underslab conduit Reroof Inspections Date I Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. Eqpt.bonding Sign Inspections Date 1 Insp.
160. Service panel 280. Setback/overhang
161. Final electric 281. Footing
282. Conduit/wiring
Mechanical Inspections I Date Insp. 283. Disconnect _-
180. Venting/flue 284. Final sign �-
181. Furnace/A.C.
182. Rouch HVAC -- Miscellaneous Insp. Date Insp.
183. Fire dampers 290. Fire alarm
184. Fumace compartment 291. Underground supply
185. Combustion air 292. Fire sprinklers
186. Smoke detectors 293. Monitor system
187. Metal F.P.rough 294. Hood dry chem.
188. Compressor setback 295. Final
189. Commercial hood
190. Duct shaft Sewers&Offsite Insp. Date I Insp.
191. Final mechanical 300. Lateral(main to P/L)
301. Saddle/Y --
Block Wall Inspections Date Insp. 302. Cess•ool filled
200. Footings 303. Sidewalk
201. SteeVrebar 304. Driveway
202. Grout lift -1-tif!j � 305. Curb replacement °
203. Final wall 306. Trash bin
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.VINE GE`OTECHNICA N
L
NOTICE OF FIELD OBSERVATION
CLIENT: /11 ,A j UIPr,� t�[)v/c DATE: 45/o(.0 TIME: / U IC:
LOCATION: /�� fe
REQUESTED BY: a-%,1 MET WITH: O a
(Title) (Title)
SPECIAL CONDITIONS: 6
(Weather, Job Shutdown, Advice Ignored, Safety)
WE HAVE OBSERVED THE: J / fey/60'1
APPROVED PER
THE PLANS CALL AGENCY INSPECTOR ❑ DISAPPROVED IV‘BELOW
SKETCH OF FIELD CONDITIONS: NOTES & CONDITIONS:,,,, „e„a, ,vo, .e/
A }} ri S )l4G7,c/4. eilfir
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I____ - - ---- - _ -
ADDITIONAL SITE VISIT(S): ❑ REQUIRED OT RE ED ❑ POSSIBLY RE
REPRESENTATIVE OF IRVINE GEOTECHNICAL: REQUIRED
HOURS: „2,--(2 Hour Minimum Charge) NOTICE L , WI H:
145 N. Sierra Madre Blvd, Suite 12 • Pasadena • California • 91107 • Phone 626-844-6641/Fax 626-604-0394
r
{ FILE NO. "i/r.reeq'
iti
DATE FILED -s/,//d6
APPLICATION FOR HOMEOWNER ASSOCIATION
j ARCHITECTURAL DESIGN REVIEW
(SHORT REVIEW PROCEDURE)
A. PROJECT ADDRESS 1 /09 '11q Ie Vii a n n @-• f -ead t 91 9 ioo,
J k
B. PROPERTY OWNER H1 (h(1'e1 7 and Cc-1;44'W_ I3R.�•l-ee.I Han nc
ADDRE S (IF DIFFERENT) 11
TELEPHONE NUMBER (k a6) 3 56. 5 26 6) Cad) 6 2i- • 01 2 6 (Celt- "-Hua)
C. APPLICANT (IF OTHER THAN OWNER)
ADDRESS
TELEPHONE NUMBER
D. DESCRIPTION OF PROJECT (check applicable)
[ 3 ENCLOSED ADDITION TO MAIN DWELLING
SQUARE FOOTAGE TO BE ADDED
[ 3 UNENCLOSED ADDITION
SQUARE FOOTAGE OF ADDITON
[ 3 ROOFING
SPECIFY MATERIALS
M EXTERIOR ALTERATIONS (describe below)
[4 EXTERIOR WALLS OR FENCES (describe below)
[ ] OTHER (describe below). •
?ovf and (ayitt e_apIti9
_ - tA)( y- • Iron rencx on - A 5t tits la en,u.,„ rocs( enelose j
h'e{- �bon s 1.- o n ;-I-e. -6 £q1 wM,e__ OctK rf ec � roofs tto - h u.rrnt(a
d.rtmceftta,t, ti atd t'eukd as Keui
NUE 4/4/. ......
}
RANCHO SANTA ANITA PROPERTY OWNERS
ASS 0 CIATION
` >; - ��DATE
WE, THE UNDERSIGNED (SIGNATURES) OWNERS OF ADJACENT PROPERTY, CERTIFY
THAT WE HAVE READ THE FOREGOING APPLICATION, AND HAVE SEEN THE PROPOSED
PLANS, AND HEREBY GRANT OUR CONSENT TO THE PROPOSED PROJECT.
# ON MAP SIG '.TU'E OF OWNER ADDRESS
•
.t 2. _mine
11W- L2e-"6 .‘
4,
5. 7s ( cor7 Dr
6.
7.
ADJACENT PROPERTY OWNERS SHALL BE CONSIDERED TO BE ALL PROPERTIES WHOSE
BOUNDARIES ARE, IN WHOLE OR IN PART, CO-TERMINUS WITH THE SUBJECT
PROPERTY:
EXAMPLE:
2 3 4
l ti
001 of 3
1 SUBJECT 5
PROPERTY
STREET
.....
.........
AOa - l 1 10 Z
CITY OF LIB rr �e�1 11�-0� . .
. _
...
240 WEST HUNTINGTON Di2IVE v ti.+ \ �..Jl ►is BUILDING SE1 V 1 'ES
:4RCADIA,L A 91/07 (G26)57'V 11 G
"OWNLrR-131111.DT,•R DECLARATION.,
Application is hereby made to the Building Official fora permit subject to the mndltions I hafreby auu,n under penalty of periury that.I stn exempt from the Contractor's Liednee Laq for
and restrictions set forth on this application. the fallowing re:r;on (Sec. 70315 Business and Paofesawns Code: Any city or county which
--..-_---.--- ----•.----------.--_------------.--------•"'------ requires n permit to construct, alter, improve, demolish. or repair any structure. prior to t:
Workers'Compensation Declaration issuance,also requires thn applicant ter such permit to file a signed statement that he or sits is
I hcrcby affirm under penally of perjury ere of the following: (check appropriate line) licensed pursuant to the provisions Qt.-the Contractor's Lieensc Lmv(Chapter 9(commencing with
_r have and will maintain a certificate of consent to self insure for worker3 compensation, Section 7000)of Division 3 of the Bm
um oss and Professions Code or that he or sho is exempt
as provided for by Section 3700 of the Labor Code,for the performance of;hc work for which therefrom and the basis for the alleged exemption_ Any violation of Section 7031.5 by any
this ctmit is issued. applicant fora permit subjects the applicant to civil penalty of not moro than five hundred clotars
I have and will maintain workers'compensation insurance.as required by Section 3700 of 5500.00):
the Labor Code,for the performance cite work for which this permit is issued. M'workers'
ootllpcnsari011 lnaurunGC carrier—and posies numbers arc
Q I.as owner ter of the prop'.or na'emp,oyooe with wages Ss their Cole compcn:a-ion,will do
\ 14905'0? lire work And thn structure is not intended or offered fOr nate(Sec.70d4 Business and Professions
Carrier . 0� Policyd —02 Code:The Contractor's License Law dent:not apptty to an owner of ptuperty who buiidr; or
Improves thereon,or who does such work himself or herself or through his or her own employees,
CERTIFICATE OF EXEMPTION FROM WORI,1tiR5' provided that such improvements are not intended or offered for sale. I.C.however,the building or
COMPENSATION TNSt RANCE improvement is sold within one year of onmpletion,the owner-builder will have the burden of
proving that he or she did not build or improve for the purpose of sale),
I certify that in the performance of the work for which this permit is issued.I shall not employ ❑ I.as owner of Me property,stn exclusivcly.coanbcting with lionised cono-eeturs to construct
any person in any manner eo as to become subject to workers cornpecesaon Laws of California. the project(Sec.7044 Business and Professions Code:Tho Contractor's License Law does not
and agree that if I should become subject to the workers' compensation provision,of Section apply to an owner of property who builds or improves thereon, and who contracts for ssch
3700 of the Labor Code,Lethal(forthwith comply with those provisions. projects with a contract(s)licensed pur.,u;int to the Contractors License Low).
0 T pm exempt under Section_ ,B.&P.C.for
Applicant:_ ..
WARNING: Failure to secure workers competcwt,on insurance is unlawful and shall subject an YG73o6:__ - ---
—
employer to criminal penalties and civil lines of up to one hundred thousand dollars(5100,000), OwLR,
in Addition to the cost of compensation,damages as provided for in rho Labor Code,interest and — AA"I'L':__ —
attornc y f-ces.
LICENSED CONTRACTOR'$DECLARATION TION .W T certify that I have read his application sad ionic that the above infatuation is correct and :
I hereby unbar under penalty of pet3uty that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 M the Business and Professions Code,and my am the owner or e duly etcher z d agent of the euth Myna.I agree e comply with all city and t e
laws relating to building conatruotion and hereby authors- representatives of the City of Arce
license is in full force and aafteet, to enter u an thy, rave-mentinccd prop ty for inspec Purposes,
License Number � o S3 License Class (1-A l0 - ��— I/, -� ,0� - f'•
Expir iaen Dote of Contractor'p License—,_ ' 1.3)P1)9 4 I• : re o"ow •,pngent or contractor ,it
c t�.t., LL.G ELECTRICAL PERMIT
nl'1i'4Lr1� a'rp.•i i3 IUill:;,, 33.,, .,7.n.,.ry3,i`y:,ll:!;-cmi!::::..tlii,e .ilr,nt., ••::rr,,,n:nu ,, .... .;suns 46 ,.,,.a., in .,.,...,,.,
...„q.,,. ,1;'1'•r 1 Ili.'FQ 3 ':11''i3,.
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3,,y 3. ,,
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3.,f ',mi,1 ),.:!, '' ,.0 ii 11!'i,;�,'113' 1:',,`1'43+'! ''.13.,1;it 'l .,;i�i,, nr 13° ,,.,1i,3'fi:::
if3t,1 C 33Y.ii air's;;:;; }.
3(3,,:1!Iy, Berner Electric, Inc. 1 il: r li .,3 " ,ll+r +1,.11i� 3601 try— --00:.i ' �•: 3 .,r. ,siM14 ::: 1. ;�3;!i-,:li, 33+:�:::,. .. Y Y�'1 rY ' a'-1�I 7a5 ,a:.�,
�..�i'...d,.VI! 255 Citation Circle 43'3,.1;,1;', (l ,. ,.:i33 :, n,c 3'i.,' it'! 3ii'3i!,."u•a•,,.I.. . ..-. _..
+>:'�b ,I iC�tt��'yy i ' 411 I , > . .,. ._.. ......._....--..
iy tp.u.;.ra: ,:•;.!.,A,,,:'.,:+,•,:,;f!-!3 3`•.,1,•,.:,,,l 4,? .l ll3ii`+:i' rill i
f•.�...ii 33 3!- ii ',t il'3,!3 :;;;,? 3',' t-d,. h.,fl ,3 la's r,i331;. , 311, f y;�'q ._7E'1
,1 .,. t,:,, Corona CA 92880-2523 3l:+. l,, n:>d i. �;'>.;,3 it 3 .,1 a Il.i...� , h 1 Z(
���3i1�rf'i' � ,;1`,•.:•u:.�;,,,, ,i3i�)i ,.3;;:{ ,!.� �ifi li'°: t;l'�,'v l i!'t3 r _. ...,. ... ...
Al*— 1+!1'1 I':;n,l1:1,,.J'q::•••t i 13;:3J-0-5 i,:,,t:, ,,..ial?i� .,'n3f,,.i a:b!;,•'1;.,,.,. -,..:;.1,
'3) ,, if,..,y.•;,,.lt>):i ,.,.>(1.!I ,:,'i!!ii IIi�iris t p� ;s ..
.. ii,l.11l'i:,:,I;:.,+i,:,at;' lil'd';3' ,;,:,::.�:f1 131lt1„,'�11 3' 1-!l is"',i' G! 4)., Description
1,.,•• -l3 j �l� . �...;�>:;I���z:.I;3�l,i 3 ! �?i,ii,>j3• � 3l 1�"�I:�t,,.. . . :,�'• P Fee, No. Am t.
�1 3 3°r:h: 173°, !1t :a?e,:, l l' ',. i,l' 3 t. , ,n•ri i
113:1�1,,;�;,.�i1 � >,l 'i a�i;,i 1• , i ,t,ii� i;lj;i„.:���,e;liii;��f;,� ,1)�ri.l,lli, � �.>f:, �� �>
i�1P.. ,''`a ;ti,3..,. 33.l+ it. i+ul 3:
Description . No. Amt. Power Schedule for Equipment Rated in
FP,KVA, KW or KVAR
1-20 receptacle,switch or lighting outlets 1.40 ea. Over 0,not over 1. each 6.90
Each additional switch,receptacle or outlet 0.90 Over 1,not over 10,each 14.10
1-20 lighting fixtures or lamp devices 1,40 ca. Over 10,not over 50,each 35,35
Each additional lighting fixture or lamp IMEIOIIIIMIIMIE Over 50,not over 100.each 70.55 •
New residential constriction 0.05 psf" Over 100,each 113.00 NM
New assessory structure w/new dwelling 0.04 psf* 3 Jki 400 amp or less residential service 14.10 M
Residential appliances not exceeding I HP 5.65 ea. 200 amp or less commercial service 14.10
220 or 240 volt receptacles 5.65 ea. 201 amp to 1000 amp commercial service 56.35 ~
Swimming pool and/or spa Over 1000 amp commercial service 141.35
Branch circuit for one sign 56.35 Each additional meter 14.10
?or each additional sign branch circuit 5.65 Distribution panel_each 14.10 I Jt'.o I 0
vliscellaneous Temporary power pole w/service panel 28.25
all Description of Work; Each additional power pole w/panel 14.10
Solid Waste Management(SW1l+1F)and 41.25
Processing fee ,,
Total fee,including Processing and SWlvff /,T ''
a Price per square foot
11;13-01 .09:07am From-CDD
6264479173 - T-617 P.01/01 F-897
'%-...itry u►rii-u auto
•
= * , j;.' .240WescYunt9ngtonOtie •E��CTRICAL - MECHANICAL -.PLUMBING �•,'Arcadia;CA 91006-6021 PERMIT WORKSHEET ,
•
C1� 626)'574,5416 • „
•.f
. . .' ,\o 6‘, "p-�;1'1C,1't-NA ' ,
•BUILDING ADDRESS . - 0 ? „'
OF WORK. . ELECTRICAL � �-----
DESCRIPTJON .. • t r r
•--) .,VALUATION ,
�J`'� TYPE OF CONSTRUCTION NEW
SQUARti'FEET - i
•
- : ARCADIA OAKS .LLC , PHONE,",
949 7 :=9. �3
OWNER NAME'" ,
2000 NEWP01t2T ';',.1.3.
;REGAH . ZIP 9266
3501 JAMBOREE 'ROAD,' /SUITE city STATE CA
■ ADDRESS g9 73" 3171
BERNER ELECTRIC,' INC., ?HONE .
r APPLICANT.NAME� .- - ,. .• � ,. .
• . . CORONA• sT;dTe CAS� ' �zia 9.2$-8.0 ,t;.;
AD_,:',...,DRESS
.; .55 -CITATION CIRCLE'' CITY ;' ;•',
' ' CAL METRO BUILDERS INC.. PHONE,.,.
CONTRACTOR::.. ----._.,-. - - CA 26 6 i�
3,S, 1 . JAMEOREE ROAD,.-, $UITE• •1000 CG)INEWPORP BEACH ...STATE ZZPl� O
ADDRESS':•.--4.-1.---: ; -�`e. �
' 4.8 5'822 CLASS C 1 0. EXPIRATION DATE 10 3 1 1 O 'CITY LICENSE-140. ,.
ti-ce!JSE NO, LICENSE
STATE .,�.
,..r,a ,:" ' 1 c•,L'U 'BIN.a,$YbSTE , f :1,1.
# #of.Unit& Descrlptaon .
#of Units Qesciiptton (Addhlons,Commerdal,■ndusufaI)
L r Te o va ry P a we r,-..
P;.ole .. #of Paels:: ........7......,,_.;_•___:.. tu ti > ..
. 1 I Services .. :: , Sze .4 Q.P. AMP. .... � ,_ ..,:.:..L:.,,....,......:........:;.,,....
.
...._'Outlets(Receptacles Switches) :. ..._ • - , Water Closets' -•
ry
-:.Fiktures l .. r --• . .•--'- • - ._...., w .... Lavatories
Mo tors P ESC1: -. ._.._ _. - :� -
Bidet• :«
}
Subpanel: 2 O 0 AMP , Siie:
Kltchah ''�•
yn,..
.
Sign Branch Giro: ,, . . , ._ .. . . : :.- ... �.
. a... . . ... 1):1 hwashers ,1...;
.,Pool Wlrinq -
i: •- -` p s Deals .
Mlsoellaneous
• :G�rbage I p•Sq,Ft:Artie:N6w Ras:•Bldg Sq,Ft;Area• New Res.. • Floor Sink _
Floor Drain
Of F to-. . '. . at'.rndry:Trays
' ' #,of Units -:•=D'earlpt .._.__..___ . •, _
Ipn
cludln '100:000 BTU •thg's Washer 4'
• :" "FAU'tb and in 9 ...... G b
' FAU•over.100,000 tTU '.. -
Grease Trap'
._ ... _.. ,....-
'
• -• • ° "Floor!Wall/SUSPHeater F ^
' -,_ b i 7. ,, _ -'U . Ga's Sy3tems-#outlets' :
+� '
;
••. , e-Fa Flre lace . -:� _ .r -• . _.. _ , y,. ,7;�..:,i;
• Kit oten Exhausiyood " . Shower Pan RQplacement' :'•
.. _ -•-• - -�
etila
tlon Fa .Including duct(CON and IND only)
sw1 rt A P ; ,
Boller/Compressor.to and including 3HP '
......._.. . ...._. a .... .,..•Poo(Wat r Heater , �•`•to 1.5HP _,.._. c'
• ° ' holler/Com ressor over 3HP ,.
.V�Fater'Hea s,
'' Boller./Compressor over t6HP'to.30HP
--•r.•- nip®ctlons.
•• or over'30HP to 50H • •-
.. .. Com ess - ,....•
• Boiler/ .Compressor over:5OHP to 1,75HP: .
Lawn;Sprinkler•Syst®m 5.7,-.;,,•
,'Air;hfandler to and.includlnr .10,000'C M•• .•Miscellaneous 'I "
Alr-Handler over 1QL000 CFM ... ._._._._. _ ..-.._ -•
... 6 fe/Add Registers or Ducts...... ' .... :. : :1-i' ;.
Evaporative Cooler, --
Miscellaneous .. .
#800 3
1/N 3;'/A e51-4i--6-5
Z0 -t- / c1� pGm� 76 5� 3
i-
mam
Date and A TION/
— iInitials / \,, .&\c.,c ,' ,�■° e0
•
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and
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of !t° °\,L'N 'Q ,cc' c;., Notes
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99 4 VEST HUNTINGTON DRIVE TY OF A R V A i BUILDING SERVICES
LRCADL9,CA 91 007 (626)574-5416
V 4 "•OWNER-WI ILDERDECLARAT ION'"
pplieation is hereby made to the Building.Official fora permit subject to the conditions I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for
ad restrictions set forth on this application. the following reason(Sec.7031.5 Business and Professions Code: Any city or county which
------ ----------- �--- requites a pemtit to construct, alter, improve, demolish, or repair any structure, prior to its
corkers'Compensation Declaration — issuance,also requires the applicant for such permit to file a signed statement that he or she is
hereby affirm under penalty of perjury one of the following: (check appropriate line) licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with
I have and will maintain a certificate of consent to self insure for workers'compensation, Section 7000)OF Division 3 of the Business and Professions Code or that he or she is exempt
s pro ed for by Section 3700 of the Labor Code,for the performance of the work for which therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any
us t is issued. applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars
I have and will maintain workers'compensation insurance,as required by Section 3700 of ($500.00):
le Labor Code,for the performance of the work for which this permit is issued. My workers' ❑ I,as`owner of the property,
ompensation insuranc carrier and oli numb are: p perty,or my employees with wages as their sole compensation,will do
fP ' the work and the structure is not intended or offered for sale(Sec.7044 Business and Professions
:airier LI 1 V 1 lien# L 7i 1 L{I—t 2i � Code:The Contractor's License Law does not apply to an owner of property who builds or
improves thereon,or who does such work himself or herself or through his or her own employees,
L& L provided that such improvements are not intended or offered for sale. If,however,the building or
CERT ATE OF EXEMPTION FROM WORhTRS' improvement is sold within one year of completion,the owner-builder will have the burden of
COMPENSATION INSURANCE proving that he or she did not build or improve for the purpose of sale).
certify that in the performance of the work for which this permit is issued,I shall not employ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct
ny person in any manner so as to become subject to workers compensation Laws of California, the project(Sec.7044 Business and Professions Code:The Contractor's License Law does not
std agree that if I should become subject to the workers'compensation provisions of Section apply to an owner of property who builds or improves thereon, and who contracts for such
1700 of the Labor Code,I shall forthwith comply with those provisions. projects with a cgntract(s)licensed pursuant to the Contractor's License Law).
❑ I am exempt under Section ,B.&P.C.for this
1pplicant: •
WARNING: Failure to secure workers compensation insurance is unlawful and shall subject an reason:
:mployer to criminal penalties and civil fines of up to one hundred thousand dollars($100,000), OWNER:
n addition to the cost of compensation,damages as provided for in the Labor Code,interest and DATE:
inomey fees.
LICENSED CONTRACTOR'S DECLARATION — I certify that I have read this application and state that the above information is correct and that I
i hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 am the owner or a duly authorized agent of the owner,I agree to comply with all city and state
'commencing with Section 7000)of Division 3 of the Business and Professions Code,and my p y n
icense is in full force and effect.
laws relating to building construction and hereby authorize representatives of the City of Arcadia
/ to enter upon the above-mentioned property for inspection purposes.
:icense Number 52 410 / Licens lass _ _
Expiration Data of Contractor's License
�5/
Signature of owner,owner's agent or contractor Date
MECHANICAL PERMIT
Building ez ' Contractor ^
ra # / .:1'a ,t 1. fit �i D 4„
Aq iic&lIt ;' 3 y i3 9,'1�y 3 y `.. ' s£::- y yr '£} £y£i i y. } s y£f y t dreS$ it _
-- i >a t ii a a , ai }j�}£�i jet } 3 �!i!:y i
., r r s 3 iii l d i } � �
i tl ,. , y ',p i y. t - £} i i 1 _ CI State ..,'° ,,,tg, .s
i r i!i# � � 1� s•C ulbel
Stat4 .. ,.tlr..... Qne nmbe; Description Fee No. Amt.
Description Fee No. Amt. Installation or relocation of compressor or 17.00 } �,,{�-�
boiler to&including 3 HP or 100,000 BTU ( L�'C/.
Installation or relocation of each forced air 17.00 ,r Installation or relocation of compressor or 31.10
or gravity furnace to 100,000 BTU, 3 (� boiler over 3 HP or 100,000 BTU to and
including ducts and vents attached thereto including 15 HP or 500,000 BTU
Installation or relocation of each forced air 21.30 Installation or relocation of compressor or 42.50
or gravity type furnace,including ducts and boiler over 15 HP or 500,000 BTU to and
vents attached thereto,over 100,000 BTU including 30 HP or 1,000,000 BTU
Installation/relocation of each floor furnace 17.00 Each ventilation fan connected to a single 8.50
Installation or relocation of each suspended, 17.00 duct and not located within a dwelling unit
wall,or floor mounted unit heater Each air handling unit to 10,000 CFM 12.80 i 0 XX%
Repair or alteration of an appliance vent 8.50ea. Each pre-fabricated fireplace 12.80
Repair,alteration,or addition to existing 17.00 Each evaporative cooler 12.80
heating,cooling,or absorption unit Each kitchen grease hood 12.80
Full Description of Work: Miscellaneous
Solid Waste Management(SWMF)and 41.25
Processing fee
Total fee,including Processing and SWMF I1g 01
C,..,ificate No. 2002408 – 248
ARCADIA UNIFIED SCHOOL DISTRICT
234 Campus Drive, Arcadia, CA 91007 •• (626) 821-8300 Ext. 6732
(Certificate of Compliance with Fee Provisions of Government Code Section 65995)
This new Fee Schedule is effective April 8,2002. Any Developer Fee worksheet brought in on or after this
date will be charged at the new rate.
Address of Development: 1109 Eng l emann C t. , Arcadia, CA 91006
Number of Buildings in Project: One Plan Check Number: 03-83
..........
[ ] Exempts 500 sq. ft.or less. Future kX] Residential2 [ ] Commercial/Ind.2 [ ] Com/Ind Parking2
additions chargeable at regular rate. $2.14/sq. ft. $0.34/sq. ft. $0.17/sq. ft.
Area in Sq. Ft.: 5,591 A developer may request refund of fees to the
District within twelve months of payment of fees,
in the event the Building Permit expires or the
Developer Fee: $ 11 ,964.74 project is canceled. The refund will be reduced by
a $100 administrative fee. The refund check will
Receipt No. kX] [ ] N/A be issued in the name of the original payee and
mailed to the address of payee, as shown on the
2 2 0 7 7 7 original Certificate of Compliance.
Part of Phase Ill , Anoakia Estates
Owner:A rcad i a Oaks, LLC Developer: Mark Smith, Hover Dev. Co.
Address: Address:
3501 Jamboree Rd. #2000
..._.__....._.......
Newport__Beach, CA ___.92660
Home Phone: ; Business Phone:
949-725-9600
Pager/Cell Phone: Pager/Cell Phone:
1This is to certify that the above-described development has been determined to be exempt from the developer fees
of Government Code Section 65995 and a Building Permit may be issued therefor.
2This is to certify that all fees due to the Arcadia Unified School District, under provision of Government Code
Section 65995, as a prerequisite to the issuance of a Building Permit by the Building and Safety Division of the
Planning Department, have been received. Based on the information presented above, this Certificate of
Compliance is hereby executed.
> The District charges a $100 fee to process reinstatement of the Certificate of Compliance resulting from an
"insufficient funds" check in addition to a$20 fee for the bounced check. Only cash or a Cashiers' Check will
be accepted as payment thereafter.
The District charges a $100 fee for any amendments to or cancellation of a Developer Fee Certificate of
Compliance issued on any type of development. Said request for refund of fees paid to the District must be
made within twelve months of payment of fees. No refunds will be issued on fees paid prior to the twelve-
month limit for any reason.
Applicant confirms that he/she is authorized to sign o• .ehalf of the owner/developer and that
the information he/she provid-• her-in is true . , a ura to th— st of his/her knowledge.
Signature of Applicant: 11 �,,
r
Approved: C\ . April 7. 2003
Assistant Superinten –Business Services Date
WHITE—Applicant YELLOW—Accounting Dept. PINK—Business Office GOLDENROD—Chrono DevFeeForm:4-08-2002
tati° .,:
4111•1*. Obits,
'
••
\ac ., y�a.4/` C 1 l OF All CADIA
240 West Huntington Drive
Arcadia, CA 91007
ATTENTION: Community Development Administrator
ST BJECI.: Grading Verification for Project No. �c 72 4 i .5 2
Address: * 7D I 0. 100-Fil 1 // B1✓c/,
A rcaclia , C'a. . _4/coca
Gentlemen: //d9' 5 d1 -e fli Au)
Finish grading operations have been completed for Project No. 7 4 2 74 for
Lo i 0 through (if applicable) and has been inspected
b the undersigned Registered Civil Engineer e.. r cen : h •t
Based upon the observations, the grading subsequent to the Rough Grading has been
completed in accordance with the approved plans and specifications and is in
substantial conformance with the final grading plan approved by the City and no
unauthorized deviations were made.
All required surface drainage devices have been installed. Provisions have been made
for drainage of surface waters around proposed buildings and their appurtenances.
tL#
ngineer{Signs u re) 4�QR10F�S�{pN�` clutect(Signature)
R.C.E. No. /3 70 3 A..'
� ,�� N�9�- ' No..
Date: yZ�U L/( No.13703 ! `'
:xp. 3/31/05 4D rn
Received and approved: 'k * ,
i
F CAL1 �ate:
C.D.D./Planning ---
cc: C.D.D./Maint.Ser.
C.D.D./Building
".IT., PLANNING SERVICES
A1lENTION: CO f! DATE: 2-/7-0i
FROM: BUILDING SERVIC S INSPECTOR: V 0/7/f-7
PROPERTY ADDRESS: //o g 614
PERMIT#: PLAN#:
CONTRACTOR: (tea' PHONE#: V' 3 75 ©O/ 2
OWNER: PHONE#:
PLEASE INSPECT THE FOLLOWING ITEMS FOR CONFORMANCE WITH APPLICABLE PLANNING
REQUIREMENTS.
' TYPE OF INSPECTION DATE & INITIAL DATE & INITIAL FINAL APPROVAL 1
LANDSCAPING/IRRIGATION // ,Z, l�4/
TRASH ENCLOSURES /r `
PARKING/DRIVEWAYS /
STORAGE AREAS 7
I
MECHANICAL EQUIPMENT
WALL HEIGHT
LIGHT HEIGHTS
BACKFLOW SCREENING
1
i
GRADING
e
COMMENTS: w/ •. i ....ALA_
Ork-
3/5/97
• OF4.
. ii.,..'- . 7iA 6
i" ARCAD A
l�\ o9
0.0RAT,„-a MEMORANDUM
Fire Department
DATE: January 6, 2004
TO: BUILDING DEPARTMENT
ATTN: INSPECTOR Zurick
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 1109 Englemann Ct
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
DATE / INITIAL
TYPE OF INSPECTION PERMIT NO. FINAL
INSPECTION
FIRE SPRINKLERS B00-015-699 12/30/03 J Perumean
FIRE ALARMS
TANKS
HOOD & DUCT
KNOX BOX
OCCUPANCY 12/30/03 J Perumean
COMMENTS:
Emailed Bldg Dept 1/2/04 - E Massey
`y CITY OF ARCADIA
.. . . , , DEVELOPMENT SERVICES DEPARTMENT
Inter-Departmental Inspection Request
Date: Z —l7.-p Y
To: Public Works Inspector From: (i5-0477
Address: //7? , Z747 7 Permit No.:
Contractor: GG 7 Phone No.: 1? 3-75<- o'/?
Owner: Phone No.:
Please inspect the following items to ensure that the contractor/developer is in compliance with
all conditions of approval established for the project, and that the work performed meets the
City's standards for Public Works construction:
Type of Inspection Date & Initial Date & Initial Final Approval
Drainage 1 _ _
Grading _
Erosion Control
Offsite Improvements
Construction Bin(s)
Street Improvement(s) 1 �� � /
(conduit, curb/curb &
gutter, curb nos., 1 Z1 I3 lf) If
driveway approach,
parkway planting,
sidewalk, street light,
traffic flow, etc.)
Sewer(s) (lateral,
grease/sand interceptor,
saddle, wye, etc.) ,
Comments: FRI\Nre
cc: Public Works Services Department — Sewer Inspector
Rev. 1 1/9/99
02/13/2004 11:07 1 PUBLIC WORKS P GE 02/02
0
Via,; WATER DIVISION gr
•
Ras ,
ATTENTION: Te31 DATE:
FROM: BUILDING DIVISION , INSPECTOR: 041
PROPERTY ADDRESS: //o `� ry7 0 ig70r7 GW/'
PERMIT NUMBER: PLAN NUMBER:
CONTRACTOR: 66•ly PHONE # 37 - o4
OWNER: ___-- .� PHONE#
PLEASE INSPECT TEE FOLLOWING ITEMS FOR CONFORMANCE WITH APPLICABLE
DEPARTMENT OF PUBLIC WORKS REQUIREMENTS.
c,
TYPE OF DATE & I DATE & FINAL -
INSPECTION INITIAL INITIAL APPROVAL
METER LOCATION
C .,
BACKFLOW DEVICES
/I)/° Ye(1 . .
IRRIGATION SYSTEM I )V/j,k
FIRE SP.SYSTEM. tvii3 r
METER CLEAR A.P.P. ^_
SWIMMING POOL
COMMENTS:
7(4,0_Z1- WorddaraiWarerdivision9-28.01
9/28/01
'1
WATER
RECLAMATION
SOLID WASTE MANAGEMENT COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
..r
1955 Workman Mill Road,Whittier, CA 90601-1400
Mailing Address: P.O. Box 4998, Whittier, CA 90607-4998 JAMES F. STAHL
Telephone: (562) 699-7411, FAX: (562) 699-5422 Chief Engineer and General Manager
oun ► ot��� 7:00 a.m.- 4:00 p.m.Mon.-Thurs.
7:00 a.m. - 3:00 p.m.Fri.
Account No.: 0406380
District No.: 15
SEWERAGE SYSTEM CONNECTION FEE
Date: June 28, 2002
Property Owner: ARCADIA OAKS LLC
Address of Property: 701 W FOOTHILL BOULEVARD
ARCADIA, CA 91006
Thomas Guide Page:
Contact: GARY PETERS, SUPERINTENDENT
Phone: 626-836-6589
Mailing Address: 3501 JAMBOREE RD., #2000
NEWPORT BEACH, CA 92660
County Assessor Map Book, Page, and Parcel Number: 5769-009-003
Structure is Proposed.
User Category and Units of Usage:
Category: O 1 A
Number of Units: 31
Square Footage:
CONNECTION FEE CALCULATION
31.00 X $1,250.00 = $38,750.00
Number of Units of Usage Connection Fee Per Unit of Usage Connection Fee
SPECIAL CREDITS: DEMOLITION CREDIT $38,750.000R
Demolition Credit
COMMENTS:
$0.00
Connection Fee Due
i IS T RIC I S
Fee.Payment Received From: Processed by: :MLII
' LOS ANGELES COUNTY• ,
N/A Amount: Approv d by: APPROVED 0,4
Amount: $0.00 Ck. No.:
D.C.: Date: June 28,2002 JAMES F.STAHL
CHIEF ENGINEER&GEN.MGR
BUILDING DEPT COPY VALID ONLY WHEN STAMPED
0 Recycled Paper
+1
POST
SURVEYING
I N C MAY 2, 2003
CITY OF ARCADIA
240 W. HUNTINGTON DR.
ARCADIA, CA 91066
ATTENTION: BUILDING DEPARTMENT
REFERENCE: ARCADIA OAKS PROJECT—TRACT 52745
LOT 10— 1109 ENGLEMANN COURT
THIS LETTER SERVES AS MY VERIFICATION OF BUILDING FORM BOARD
SETBACK LOCATION &F.F. ELEVATION PER THE PRECISE GRADING &
BUILDING ENVELOPE PLAN PREPARED BY KEITH &ASSOCIATES. THE
FORM BOARDS ARE IN SUBSTANTIAL CONFORMANCE WITH THE REVISED
FINISHED FLOOR OF 669.08 AS SHOWN ON PLANS WITH THE LATEST
REVISION DATED 3-26-03. THIS VERIFICATION IS BASED ON A FIELD CHECK
ON 5-1-03.
SINCERELY,
(41)
RON POST
PRESIDENT
v_ANOSu,
t 0 o.0 ,
P.L.S.4832 Imi
+i 1110►111'ioe Alk
Op Com cr
LAND SURVEYING AND CONSTRUCTION STAKING
2524 FENDER AVE. UNIT G • FULLERTON, CA 92831 • (714) 446-0966 • FAX (714) 446-8689
nt By:
9497259322; Sep-4-01 11 :34AM; Page 2/2
05-14-C'' 02:05pm From-CDD 6264479173 T-335 P.D2/02 F-664
:11 11116111,1 4
°'� 3 •
: , • . CITY OF ARCADIA
---"Co. - 240 West Huntington Drive
Arcadia, CA 92007
P,,OUGH GRADING VERIFICATION
ATTENTION: Community Development Administrator:
SUBJECT: Grading Verification for Project No c c-+ ,t Z7� , )
Address 70 . it , .4 ✓i • 1, i •r4 ex- r. La elk)
4rc.aeltc' , Oa. . gIoOC-,
Gentlemen: f/e7 c7-L 4:-'c 1 r y'r AIL,-
Rough grading opera tons have been completed for Project No , / M. Z 74� for
Lots. /Q. through • (if applicable) and has been inspected
.:by.the undersigned Registered Civil Engineer or Licensed Architect..
Based upon the observations, the rough grading of the lot(s) listed above have been
,completed in conformance with plans marked "APPROVED" by the City. The work
includes but is not limited to the following: grading to approximate.final elevations;
.staking of property lines; location and gradient of cut and fill slopes; location, cross-
sectional configuration and flow-line gradient of drainage swales and terraces; berms
.:installed where indicated; and required drainage slopes provided on building pads,'
Enclosed herewith is a Soil and Compaction Report for the Building Division which is
r-•aired on all new constructi,=- - o o'footing inspection:
QRO /ON\ .
' -"1"�V, MA//� -7(
r . . ..c _I.('• ,% • F
1,
Engineer(Si. afore) c7 << rs. 'tect(Signature)'
w No.13703 r^
R.C.E. No. 13i7c 3 1. Exp. 3/31/05 ; • . No •
* 1 ,
Date: -- I O -5 ti
4-\\N..._ OA "
Received and a pt roved: .
Date:
C.D:D./Plamm�.g
cc: C.D.D./Maint. Ser.
C.D.D./Building
DAILY FIELD ENGINEERING REPORT (II: '��
PACIFIC SOILS ENGINEERING, INC.
Client: 444' L , Work Order: /02 363-4
Clients Representative: iti r',ittsz� Tract No.: 52745 Date: S— 7- O 3
Project Name:
�y Day: Gt/.0.4
Project Location: Cl,,,,,,t, / Ca. Weather Conditions:
Contractor: Approximate Fill Yardage :
Type and Number of Rigs in Operation:
Description of Project Activities: J/©q'— ti4s,1 t ryn,.4w
l �.—. i�`K' ..Q�jr' !LAt- - .-......��.A . oar ..
i..�nc�at .. / .
/ .� s
er /o/ / asoe /Z
t?-0,44.~-62,40, 4 a... rior.4-1-s-e-11-ticc-liv li S-- /xers-ael4...e :
ro. a. 4 i "4
Site Visitors I Firm:
I HOURS BILLED
TECHNICIAN TO PROJECT For Pacific Soils Engineering, Inc.
Field Office
Received by
Page of __._
•
PACIFIC SOILS ENGINEERING, INC.
10653 PROGRESS WAY, P.O. BOX 2249, CYPRESS, CALIFORNIA 90630
TELEPHONE: (714) 220-0770
4 X
NOTICE OF FOOTING EXCAVATION INSPECTION
S 274$ b /ci - .�
agort
JOB LOCATION: /ma,
Ca
WORK ORDER NO.: / 236�- REF. WORK ORDER NO.:
OWNER OR CONTRACTOR: / / " `ir"
OWNERS ADDRESS:
DATE FOOTINGS INSPECTED:.
- 03
DESCRIPTION OF FOOTINGS OR CAISSONS COVERED BY THIS NOTICE:
S 2745 /0 "LW A-e-it-texter-
a-ppd'
__ Are aiee
,/
/1-14.if-7"-)0t- al'.
The undersigned has inspected the footing and/or caisson excavations listed above on the referenced property and same were
excavated in accordance with our recommendations in the preliminary foundation report and the Building Code of the
PACIFIC SOILS /E�NGINEEERRINNG, ZINC.
BY: . CZeA /C∎st %4 --
SIGNATURE
DISTR: (1) Office
(2) Inspector
(3) Project
Form 80
=--
PACIFIC SOILS ENGINEERING, INC.
10653 PROGRESS WAY, P.O. BOX 2249, CYPRESS, CALIFORNIA 90630
TELEPHONE: (714) 220-0770
NOTICE OF FOOTING EXCAVATION INSPECTION
JOB LOCATION: C ke.a.,
I
/70 1114/7 C.,-(AK /".-
WORK ORDER NO.: lot-3 3- REF. WORK ORDER NO.:
OWNER OR CONTRACTOR: 1
OWNERS ADDRESS:
DATE FOOTINGS INSPECTED:
DESCRIPTION OF FOOTINGS OR CAISSONS COVERED BY THIS NOTICE:
,. 52 74 „, - 9//0 and 1 6 41414 r; r Oc rcQIZ
bki 1 A+ c '4 c. Arc & '' a 101 dektd /0'2 44 / i r?
- 4;3 „e ' r : . - ..42.- -' -
lei;2,t, ,..-m-aitey-re,
R.,(-47,-- 7.1,, , ,ola...64..., ,,,r--e-re-ete._ a, ft,4,4.,,, --1.7-X-ea
'
s r , ' - ovize
AVe-ug‘ed Zr' '
The undersigned has inspected the footing and/or caisson excavations listed above on the referenced property and same were
excavated in accordance with our recommendations in the preliminary foundation report and the Building Code of the
G.!, ' a,CC .e- ,. C .
y
PACIFIC SOILS ENGINEERING, INC.
SIGNATURE
DISTR: (1) Office
(2) Inspector
(3) Project
Form 80
DAILY FIELD ENGINEERING REPORT
PACIFIC SOILS ENGINEERING, INC.
Client: //o ‘06M /7 CerjAr Work Order: - - -
Clients Representative: ,~ Tract No.: 5 Date: ;
Project Name: Day:
Project Location:
Weather Conditions:
Contractor: Approximate Fill Yardage :
Type and Number of Rigs in Operation:
Description of Project Activities:
4-7,
;If-
/..2///
/2 -
' - ,r7
/
4,9 a A /,
."://ie &•
r —C--k.--se •71 4,'"e4e " I 't
-
Site Visitors I Firm:
7/
HOURS BILLED
TECHNICIAN TO PROJECT
For Pacific Soils Engineering, Inc.
Field Office
Received by:
Page of
dafldrpt.sam
•
Southvw' ;t Inspection and Te. ng,Inc.
10826 South Norwalk Blvd., Santa Fe Springs, CA 90670
(562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026
SWIT Job No. Date
REGISTERED INSPECTORS'S DAILY REPORT
TYPE OF Q Reinforced Concrete ❑ Structural Steel Assembly ❑ Quality Control
INSPECTION ❑ Post Tensioned Concrete ❑ Fire Proofing ❑ Other
REQUIRED ❑ Reinforced Masonry ❑ Asphalt
Job Address City
Job Name Pgrmit No. Issued By
•
Type of Structure Architect
Material Description(type,grade,source) j Engineer
Contractor
Inspector(s)Name Subcontractor
TESTS PERFORMED
TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES
INSPECTION SUMMARY— LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT-AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED,NUMBER,TYPE&IDENT.NO'S OF
TEST SAMPLES TAKEN: STRUCT.CONNECTIONS(WELD MADE H.T. BOLTS TORQUED)CHECKED,ETC.
CERTIFICATION OF COMPLIANCE CONTINUED ON NEXT PAGE ❑ PAGE OF
I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED TIME IN TIME OUT REG.HOURS O.T.HOURS CYLINDERS
WORK UNLESS OTHERWISE NOTED.I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS,
SPECIFICATIONS,AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS.
All inspections based on a minimum of 4 hours and over 4 hours-8 hour
minimum. In addition,any inspection extending past noon hour will be an 8
f SIGNATURE\OF REGISTERED INSPECTOR hour minimum.
Approved by
SPECIALTY NO. AGENCY Project Superintendent
WHITE-OFFICE COPY CANARY-ACCOUNTING COPY PINK-INSPECTOR'S COPY GOLDENROD-JOB SITE COPY i 6803